Compare Private Health Insurance
information
1. Private health insurance – who can assure himself
The following group of persons can switch from statutory health insurance to private health insurance or generally be insured in private health insurance.
Which includes Freelancers, the self-employed, civil servants and workers and their families, as well as housewives and students. For employees: The gross income must be above the annual earnings limit (JAEG) / mandatory insurance limit. Holiday and Christmas bonuses and bonuses count towards the gross income.
If the mandatory insurance limit was exceeded in the last year, there is the possibility for workers to switch to private health insurance.
This means that at least the following annual gross salary must have been achieved in the event of a change: in 2017, annually, Euro 57,600.00 (monthly Euro 4,800.00) and in 2016: Euro 56,250.00 per year (monthly Euro 4,687.50).
The private health insurance since 2009, like the statutory health insurance now one "Replacement insurance". All persons living in Germany must have health insurance, either in the statutory health insurance or in a private health insurance.
2. PKV advantages in short version
2.1. The contributions of PKV are not income-dependent and often cheaper.
Posts: for singles = i.d.R. better
Contributions: married, a compulsory insured, an insured person with income above the compulsory insurance limit = mostly cheaper
Posts: married, a self-employed person, spouse not active = Here is possibly one "Spouse employment contract" recommended. Advantage: at relatively low social contributions, the spouse acquires social insurance (statutory health insurance, pension insurance, unemployment insurance and long-term care insurance). The expenses on the part of the employer are fully deductible as costs) = cheaper
Posts: married, be >
If children are to be insured, the contribution benefits are reduced. The child contribution is about Euro 110 (as of 2015). This changes again with beginning of occupation of the children, since these then have to assure themselves and thus the PKV contribution decreases again.
2.2. The services are more extensive in many areas
First of all: unilateral declines in benefits and total redundancies are not possible on the part of private insurers, in contrast to statutory health insurance (see also "GKV – reforms since the 70s). Once you have chosen the insurance cover, you will receive it.
- free choice of doctor (also doctors who only treat private patients)
- I.d.R. shorter waiting times at the doctor
- No drug restrictions
- no reference to cheaper similar preparations
- Appointment / assignment as necessary (possibly not by quarters)
- No foreign health certificate required (European and international validity)
- Reimbursement of many alternative healing methods (natural remedies.)
- Reimbursement for visual aids (glasses, contact lenses, lasers)
- Reimbursement for dentures up to 80%
- Reimbursement for inlays up to 80%
- In the hospital = comfort promotes recovery
- Accommodation at the private ward (single or double room)
- optionally with and without head physician treatment
- premium refunds
3. not occupied
4. Savings with private health insurance
With the PKV savings of 300 euros per month are not uncommon. In particular, taking into account that in the case of employees, the employer’s contribution to health insurance is integrated as an employer subsidy in the monthly contribution calculation. The contributions to the private health insurance are calculated differently than those of the legal health insurance not in dependence on the income. Decisive for the amount of the contribution are the age, occupational group and health status of the person to be insured. Anyone who joins private health insurance at an early age has low contributions in addition to the additional benefits.
Calculated at the age of 30, 40 and 50 years. The insurance cover includes the outpatient area with 600 euro annual participation, the Hospital with twin room and the chief physician treatment, the posterior region is paid at 80% (including dentures), it was a Daily sickness / loss of earnings from 120 euros per day from the 7th week included. The Term care insurance is also included.
| entry age | PKV lowest contribution | PKV highest contribution | SHI maximum contribution including care, additional contribution 0.9% | Savings to the gKV |
|---|---|---|---|---|
| 30 years | 360.77 euros | 583.92 euros | 746.63 euros | 385.86 euros |
| 40 years | 438.52 euros | 707.69 euros | 746.63 euros | 308.11 euros |
| 50 years | 560.88 euros | 888.51 euros | 746.63 euros | 185.75 euros |
GKV: On 01-01-2015 the contribution assessment limit has increased. This automatically led to a contribution increase. This will happen again in 2017. From all coffers a surcharge will be charged. This is on average 1.1%.
5. Excess (SB) – and the influence on the contribution amount
PKV: Usually, the private rates are offered with different deductible levels. The range ranges from 300 euros to the maximum limit of 10,000 euros and applies i.d.R. for a year. Percentage own contributions of 10 or 20%, this form is possible, but can come very expensive. Think of chronic diseases that require a permanent medical treatment and / or expensive long-term drug treatment is announced. Here the percentages can be expensive. Case – or treatment – related participations are the exception. We recommend a fixed deductible.
The private insured person has the free choice the amount and thus determines very much its contribution itself. This deductible almost always refers exclusively to the cost of outpatient treatment, this case the dental insurance is excluded. With the so-called Kombitarifen there are also other regulations. In our online health insurance comparison you will find the necessary details.
The deductible as a fixed amount Contributes to the stabilization of contributions and reduces contribution adjustments. In addition, the policyholder often benefits from one premium refunds (if not using the insurance), this can be up to 6 monthly contributions.
For a worker who receives from the employer his compulsory 50% contribution up to an amount of EUR 309.34, If deductibles and contribution levels are to be adjusted or optimized with regard to the use of the full subsidy. That In many cases it makes sense to choose a more expensive tariff (2014 up to Euro 591.40) with a lower SB, since the employer is half involved.
GKV: The co-payments / own contributions of the GKV are given. So many services not included at all or are available only to a limited extent. A certain euro size is therefore not available. Here, some experienced a nasty surprise.
- Thousands of medicines were completely deleted
- Medicines – general additional payments between 5 Euro – 10 Euro
- Visual aids – frames and contact lenses have been completely deleted
- Dentures – reimbursement only with fixed subsidies
- Hospital participation with the daily rate (10 Euro per day, for a maximum of 28 days)
- Additional payments for remedies and aids
For a very detailed overview of the cuts in statutory health insurance benefits sold as health care reforms, see Item 3.
Insurance comparison private health insurance – contribution examples:
| entry age | PKV contribution SB Euro 0 | PKV contribution SB Euro 300 | PKV contribution SB Euro 600 | PKV contribution SB Euro 1000 | GKV maximum contribution incl. Additional contribution 0.9% |
|---|---|---|---|---|---|
| 30 years | 464.20 euros | 422.87 euros | 360.77 euros | 273.88 euros | 766.99 euros |
| 40 years | 566.27 euros | 525.85 euros | 438.52 euros | 366.13 euros | 766.99 euros |
| 50 years | 704.40 euros | 681.55 euros | 560.88 euros | 498.39 euros | 766.99 euros |
Conclusion: Ultimately, the practice looks like that in many cases, this cost of the GKV significantly exceed the agreed own contribution amount amount of privately insured.
6. Employer grant private health insurance of 50% for the employee
This is a mandatory performance of the employer. The employee receives 50% of his private health insurance contribution (in 2017) for himself and his family members up to a maximum amount from monthly Euro 317.55.
7. Development of statutory health insurance contributions – assessment limits, mandatory limits and maximum contributions
| year | Post- assessment limit |
Change over previous year | Compulsory insurance limit | maximum contribution |
|---|---|---|---|---|
| 2000 | 39,574.00 euros | 39,574.00 euros | 445.21 euros | |
| 2005 | 42.300,00 Euro | 1.07% | 46,800.00 euros | 500.55 euros |
| 2010 | 45,000.00 euros | 2.04% | 49,950.00 euros | 558.75 euros |
| 2011 | 44.550,00 Euro | -1.00% | 49,500.00 euros | 575.44 euros |
| 2012 | 45,900.00 euros | 3.03% | 50,850.00 euros | 592.88 euros |
| 2013 | 47,250.00 euros | 2.94% | 52,200.00 euros | 610.31 euros |
| 2014 | 48.600,00 Euro | 2.86% | 53.550,00 Euro | 627.75 euros |
| 2015 | 49,500.00 euros | 1.85% | 54,900.00 euros | 602.25 euros |
| 2016 | 50,850.00 euros | 2.65% | 56,250.00 euros | 618.68 euros |
| 2017 | 52,200.00 euros | 2.58% | 57.600,00 Euro | 635,10 euros |
8. Private health insurance and its services
The private health insurance provides services for the
8.1. outpatient treatment:
Services for doctor treatment, medicines, remedies and aids, acupuncture, alternative practitioner treatment, alternative treatment methods, such as TCM (Traditional Chinese Medicine), etc.
8.2. inpatient treatment
Single room with chief physician treatment; Twin room with chief physician treatment and multi-bed room with private doctor treatment or the latter also with the chief physician treatment
8.3. dental treatment:
Services for examination, inlays, onlays, bridges, orthodontics, etc.
8.4. for the loss of earnings:
The sickness allowance insurance will be paid after the expiry of the agreed waiting period in the contractually agreed amount. The waiting period is optional 4, 8, 14, 21 days (and later, as you wish) for the self-employed. For the employee, the sick pay begins after expiration of his contractual salary continuation, usually from the 7th week.
The hospital daily allowance (KHT) is paid for each day of hospitalization. The KHT does not automatically belong to private comprehensive health insurance. However, the employee also receives the 50% employer’s contribution for this contribution, provided the employer’s maximum contribution of € 309.34 has not yet been exhausted.
Compulsory module for health insurance, which covers part of the actual care costs of the person in need of long-term care.
9. Premium refunds and special benefits
9.1. Rebates:
will be sold within a certain period i.d.R. If the claimant does not claim benefits for 1 year, the health insurance company reimburses the insured person for up to 6 monthly contributions, varying from insurer to insurer. In the case of an employee, taking into account a half-yearly employer’s allowance, it may lead to a zero contribution in individual cases.
9.2. Health Bonus:
Some health insurers reward the health-conscious behavior of their insured by sometimes substantial contribution advantages, for example: BMI value in the normal range, nonsmoker, etc.
In order to obtain a market overview of the companies offered (about 30) and their tariffs / tariff combinations (over 3000) including their performance, a health insurance comparison is essential.
10. Waiting time waiver and immediate insurance cover
Switch from the statutory health insurance to private health insurance so i.d.R. the waiting periods (the pre-insurance period is counted towards the waiting period) Formalities: You have the SHI create a so-called pre-insurance certificate and submit it to the private insurer. If you are switching from a private health insurance to another private health insurance, i.d.R. Waiting times to consider. These can be omitted if a medical certificate (form of the insurer) is presented.
3 months is the general waiting time. It concerns the areas: doctor treatment, medicines, medical practitioner treatment, remedies and aids, so everything that happens on an outpatient basis. These three months also apply to hospital costs.
8 months are the special waiting times. They concern the following areas: dental insurance, pregnancy and psychotherapy. Some insurers also expect a slightly shorter, five-month waiting period.
11. Submission of documents – not always with advance payment
Drug costs: When it comes to medicines and these are often used or a long-term drug treatment is required, the pharmacy will be pleased to issue a monthly statement, which you treat as explained above.
Hospital bills: If you have a hospital stay behind you, the hospital expects i.d.R. with your private health insurance directly from.
12. Compulsory insurance limits / annual earnings limits (JAEG)
Obligatory insurance limits / annual earnings limits (JAEG) and contribution assessment limits as well as maximum contributions from the statutory health insurance and minimum contributions for self-employed in recent years
The JAEG determines whether you can switch to private health insurance. From the contribution assessment limit, the maximum payment is calculated with a% rate for the statutory health insurance. For certain groups there are minimum contributions in the GKV. Attention: These are only valid for a short time and are then adjusted to the actual income. Note: PKV contributions are independent of income and are always based on the individual scope of the selected protection and personal data (age, occupation, state of health, etc.)
13. Bills of exchange – private to private health insurance – PKV to PKV
You are in private health insurance. Switching to another insurance company was previously associated with the complete loss of retirement provisions. Since 2008, insured persons can take the old-age provisions, which are based on the new base rate, on a private health insurance change. How high these provisions are, however, must be calculated. This should lead to more competition among health insurance companies. However, this has also increased the burden on insurance companies, which all insured persons have to pay. That means who wants to change his private health insurance, will have an advantage. For the insured, who are satisfied with their company and do not change, however, this scheme will incur higher costs. It is not advisable to switch for minor differences in contributions. Because, please keep in mind, every society regularly adjusts its contributions to the increased medical expenses. Moreover, it is in a deterioration of the state of health i.d.R. not advisable to change. Please compare and contact us first.
14. Termination of private health insurance
14.1. Ordinary termination
Please note the agreed minimum contract period (between one and three years) of your contract. The contract is to be terminated with a notice period of three months at the end of the insurance year. In part, the calendar year corresponds to the insurance year, i. It ends then always to 31.12. of the year. This is regulated differently. The termination should always be done by registered mail. But before you quit, you should already have the new insurance policy in your hands! Not that you are suddenly without insurance coverage. So get advice in good time and do not put anything on the back burner.
14.2. Extraordinary termination
If the contributions are increased, you have an extraordinary right of termination. Within one month after becoming aware of the premium adjustment you can cancel the contract.
14.3. Termination in the event of compulsory insurance
In the event of compulsory insurance, you can cancel the PKV within three months retroactively to the start of compulsory insurance.
15. Change from statutory to private health insurance – GKV to PKV
More than 10 million members are private health insurers and this is rising. It is not for nothing that self-employed workers, freelancers, civil servants and employees with a corresponding income decide above the insurance limit for private health insurance. Often, however, is warned and rightly so. Insurance protection should be in demand at the insurance broker. If necessary, get a second opinion. We expressly support this and also assume the resulting costs of an insurance consultant.
16. Termination of the statutory health insurance (GKV)
The termination of the statutory health insurance is basically only properly possible. That the membership of the GKV must have existed for at least 18 months. The notice can then be made on the next calendar month. The condition for the termination to take effect is that, as a rule, the employer is to be presented with a member certificate from the new SHI within the notice period.
Special right
Since the contribution rate to the statutory health insurance is prescribed by law, there is no special right to cancel a contribution rate increase. However, if an additional contribution is levied, there is a special right of termination at the time at which the additional contribution is levied for the first time. The health insurance company must explicitly point this out.
17. Always state pre-existing illnesses when changing
Please answer all questions regarding the pre-existing diseases truthfully. Please do not conceal anything that is asked for. So you are on the safe side. If you have any conditions that you think are not significant, please specify. If these lead to complications of the application acceptance, you will be made a suggestion of the contribution surcharge. You always have the freedom to say yes or no. You decide.
18. Comparison of the GKV with the PKV
| Outpatient treatment | ||
|---|---|---|
| legally | Private | |
| medical expenses | Costs of approved physicians will be reimbursed. | Reimbursement up to the maximum rates of the respective scale of fees for doctors, dentists (GOÄ or GOZ) and non-medical practitioners (GebüH) |
| remedy | will be reimbursed 85% (15% own contribution) Subject to budgeting | will be reimbursed up to 100% |
| Naturopaths | is usually not refunded | varies by fare |
| vaccinations | According to the vaccination calendar of the Federal Ministry of Health, vaccinations are fully reimbursed | According to the vaccination calendar of the Federal Ministry of Health, vaccinations are fully reimbursed |
| prevention | are fully reimbursed, depending on their age, under prescribed programs. Cash registers can offer bonuses for completed check-ups. | will be fully reimbursed for all check-ups necessary for the early detection of illnesses |
| visual aids | No refunds, except for children under 18 years and the visually impaired | are fully reimbursed, depending on the tariff up to a certain maximum sum and only in certain time intervals (for example up to 300 euros every 2 years). U.u. even before, if the vision has changed greatly. Eyeglass frames, lenses and contact lenses are freely selectable |
| Inpatient treatment | ||
|---|---|---|
| legally | Private | |
| accommodation | Shared room in approved hospitals Own contribution: 10 Euro per day for max. 14 days a year (corresponds to a maximum of 140 euros per year) | free choice of the hospital. The stay in a shared room is fully refunded, depending on the rate in a two- or single room with chief physician |
| medical expenses | Only treatment by the doctor on duty or by a district-approved attending physician is paid | 100% of the costs for private medical treatment up to the ceilings of the GOÄ, u. in agreement also about it |
| transport costs | reimbursed if medically necessary. Own contribution 13 euros per trip | reimbursed if medically necessary |
| Dental treatment | ||
|---|---|---|
| legally | Private | |
| dental treatment | 100% refund | 100% refund |
| dentures | depending on the doctor’s findings varying subsidies | Reimbursement according to tariff up to 100%. 100% refunds will result in maximum totals per calendar year |
| inlays | no refund | Reimbursement up to 100% depending on tariff |
| implants | no refund | Reimbursement up to 100% depending on tariff |
| dental Season | no sum limit | Refund limits during the first years of insurance. Not required for treatments after an accident |
| General | ||
|---|---|---|
| legally | Private | |
| refund | As a rule, no premium refunds are provided. For some health insurance companies, a model trial was started in this direction. | Depending on the tariff there is a refund of up to 6 paid monthly contributions after non-performance years (calendar year) |
| Beitragserrechnung | percentage contribution rate from the monthly gross income | independent of income; Basis: age, state of health, tariff choice |
19. Private insurance and pensioners, entitled to a contribution subsidy
20. PKV health insurance comparison – content and special features
The online health insurance comparison is conducted anonymously. You do not need to enter an address. It is a true comparison, it insurers are named with performance and premium.
Note: These are not "Base-", "Comfort-" and "Premium Rates" without naming the insurer. Also, not only a tariff offer of an insurer is expected (often as "rate calculator" shown) and as an example. We also do not advertise "from 59 Euro private health insurance", that does not exist. With our comparison calculator you have the full insight. If you have any questions, please call us or call us for your individual offer. Many thanks.
21. Association of private health insurance
It represents the general interests of the private health insurance, the private care insurance of the affiliated insurers. He advises health insurers on fundamental tariff issues. On social policy and regulatory issues / points he takes position.
The PKV Association has 49 members (42 ordinary and 7 extraordinary). The address is:
Association of Private Health Insurance e.V.
Gustav-Heinemann-Ufer 74 c
D 50968 Cologne
22. Medically necessary treatment
Unfortunately, this topic repeatedly gives rise to differences between the policyholder and the insurer. According to the terms of the contract, the health insurer pays the costs of a medically necessary medical treatment. Only, who determines the medical need? It is not only the policyholder as a patient and the attending physician! The policyholder is often left alone here. The doctor recommends and the policyholder follows the recommendation. The insurer restricts the benefit or generally refuses to pay.
The doctors are recommended, that you also refer the patient verbally to this circumstance and do not let him believe that everything is automatically covered by the insurance company.
The policyholder is recommended, before starting a costly treatment or a stay in hospital to obtain the benefit of the health insurer. This happens i.d.R. very fast.
The insurers should be recommended, deal with this topic more sensitively and generously. The policyholder first has more confidence in the attending physician and must be able to rely on his judgment / advice. This often leads to a breach of trust between patient and doctor. Who’s to blame? The insurer, that should be avoided.
The applicable conditions / terms make sense, considering that otherwise the? Overmassages? patients and unnecessary cost burdens.
23. Conciliation body – Ombudsman
Differences of opinion and disputes need not be settled in court. An institution of the European Commission has created a network for complaints in the financial services sector "FIN-NET". The PKV Ombudsman belongs to this. Out-of-court dispute resolution is carried out through mediation by the Ombudsman (and in the majority of cases extremely successful). The arbitration itself does not cost you anything.
Ombudsman of the private health and long-term care insurance is since 01.01.2014 Mr. Heinz Lanfermann. The address is:
OMBUDSMAN
Private health / long-term care insurance
PO Box 06 02 22
D 10052 Berlin
Telephone: 0800 2 55 04 44
Fax: 030 20 45 89 31
24. Judgments on private health insurance
Keyword: Contribution increase, extraordinary termination right by the UN
OLG Bremen 06-02-2014 – Az 3 U 35/13
Keyword: Laser surgery – Lasik Surgical costs, treatment by legal entity (eye center)
LG Dortmund – 05-10-2006 – Az 2 S 17/05
Keyword: deductible
Finanzgericht Köln – Ref .: 15 K 1858/12
Keyword: Remedies in simple form
LG Dortmund – 18-11-2010 – 2 S 39/10
Keyword: Premium refund, invoice not submitted, extraordinary burden
Finanzgericht Rheinland Pfalz -31-01-2012 – Az 2V 1883/11
Keyword: Supplementary dental insurance, admission insurance case
OLG Karlsruhe – 27-06-2013 – Az 12U 127/12
Keyword: alternative treatment Immunotherapy for incurable disease
BGH – 30-10-2013 – Az IV ZR 307/12
25. * Guideline for the contribution comparison – "lowest premium / highest premium"
The example shown represents comprehensible figures and comes from our insurance comparison – as of 09-2014. Guideline: Entry age 30 years, outpatient protection with 600 Euro deductible, double room with chief physician treatment, dental treatment 100%, dental prosthesis 80%, sickness allowance Euro 120 and long-term care insurance.
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